Prolotherapy

Prolotherapy is injection of any substance that promotes growth of normal
cells, tissues, or organs. Prolotherapy is performed in all major hospitals
but not by the name prolotherapy. An example is injection of red blood
cell growth stimulator (erythropoietin) in patients with anemia. The three
types of prolotherapy are:

1. Growth factor injection prolotherapy: Injection
of a growth factor (a complex protein) that specifically begins growth
of a certain cell line (erythropoietin example). This type of prolotherapy
is in early stages of study for arthritis (growing cartilage cells) and
sprain and strain (growing fibroblasts) and will advance substantially
in years ahead. It will be a more expensive option however than the latter
two types.

3. Inflammatory prolotherapy: Injection of something
that causes activation of the inflammatory cascade to produce growth factors.
These solutions often include dextrose for a growth factor stimulation
effect, but the inflammatory signals that result causes a more vigorous
growth response. Examples of solutions in current use are 12.5%-25% dextrose,
phenol-containing-solutions, and sodium-morrhuate-containing solutions.
Double blind studies done thus far have been treatment comparison studies
rather than placebo controlled studies (3-5) as the control groups received
injection with multiple bone contacts which itself will stimulate growth
factor release. Despite this, the inflammatory proliferant groups did
better except for one study in which the technique used was questionable.(5)
Inflammatory prolotherapy will likely be the most cost effective form
of prolotherapy in the future as it is an inexpensive medical technique
for stimulation of the natural wound healing cascade.

Since the primary pathology in chronic sprain/strain is best described
as connective tissue insufficiency, connective tissue laxity and/or weakness
(the term connective tissue insufficiency has been utilized), it will
be imperative to correct the primary pathology. The primary pathology
in arthritis however, is a combination of too little growth factors and
too much disrepair factors, and how to limit disrepair factors is currently
under investigation. (6)